An outbreak of jaundice in the Epping district, involving at least 84 people, had been traced previously to eating bread made from flour accidentally contaminated with 4,4'-diaminodiphenylmethane. In this paper the clinical, biochemical, and liver-biopsy findings are described. There were three modes of presentation according to presence or absence of upper abdominal pain and its severity, but this could not be correlated with the probable amount of toxin eaten. Rigors, limb pains, malaise, and obstructive jaundice followed. Jaundice sometimes lasted for months. Differential diagnosis included cholelithiasis. Serum bilirubin, serum alkaline phosphatase, and serum aspartate transaminase were raised to a varying and generally moderate degree. In a few cases there was blood eosinophilia. Seven patients had liver biopsies. These showed portal inflammation, eosinophil infiltration, cholangitis, cholestasis, and hepatocellular damage at different stages. Fibrosis appeared to be slight. All patients have now made a good clinical recovery.
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Kopelman et al. (1966) studied this question.